There is growing momentum within the Democratic Party to find its next ObamaCare heading into this year's midterm elections, as healthcare costs become more untenable and American anger over affordability persists. Healthcare has consistently ranked as a top issue for voters, with June polling from Emerson College finding it among the top five concerns, behind the economy, threats to democracy, and immigration.

The expiration of enhanced Affordable Care Act tax credits dealt a significant blow to Democrats in Congress, who carried out the longest government shutdown in history to secure a vote on extending the subsidies. In the wake of those expired credits, premiums jumped by more than 20 percent and ACA enrollment dropped this year after previously experiencing four consecutive years of record growth. While the House passed a three-year extension on the subsidies at the start of the year, Senate efforts have led nowhere, leaving a vacuum for parts of the Democratic coalition to submit their proposals for a successor.

What the Left Is Saying

Progressive groups and left-leaning think tanks say the base is receptive to major healthcare reforms and argue the time has come to move beyond the ACA. In March, the Center for Health and Democracy unveiled its proposal for a 2028 healthcare platform called 'Medicare by Choice,' which would allow all Americans the option of enrolling in Medicare regardless of age and permit employers to select it as a workplace benefit.

"It's been my experience, and I think CAP's experience, that Democrats are certainly open to new and fresh ideas on the latest healthcare challenges that Americans are facing," said Natasha Murphy, director of health policy at the Center for American Progress. "I feel like Dems across the political spectrum are certainly open and champing at the bit for ideas that would not only address premium affordability but also try to improve or lower out-of-pocket costs."

The Searchlight Institute released its own proposal last month to make primary care free for all Americans and create a nonprofit public option. Recalling how former President Obama called the ACA a "starter home" for more affordable healthcare, Searchlight wrote that "now is the time to upgrade that starter home by making health care work better for all Americans."

What the Right Is Saying

Moderate Democrats and some policy strategists argue the party should pursue achievable goals while working to regain control of the House and Senate. David Kendall, senior fellow for health and fiscal policy at the center-left think tank Third Way, suggested that voters want guarantees rather than choices.

"I think what the public is looking for is guarantees, not choices," Kendall said. "People want something that's achievable, that people can understand and that will give them immediate relief from costs."

At the start of this year, Third Way released its own healthcare memo calling for a "Health Care Bill of Rights" with ten tenets, including capping costs for everyone, ending medical debt, banning junk insurance, and prohibiting surprise medical bills. The proposal characterized the ACA as a starting point while cautioning against "high costs like single payer."

What the Numbers Show

Healthcare ranked among the top five issues for voters in June polling from Emerson College, behind the economy, threats to democracy, and immigration. Premiums jumped more than 20 percent after enhanced ACA tax credits expired. ACA enrollment declined this year after four consecutive years of record growth. The House passed a three-year extension on subsidies at the start of the year, but Senate efforts remain stalled.

Pollster Marissa Padilla of the Democratic polling firm Global Strategy Group noted that while voters trust Democrats more than Republicans on healthcare issues, Independents present an opportunity. "There is a meaningful share of the electorate, however, especially Independents, that don't trust either party," she said. "And there is an opening for elected officials, for candidates to appeal to these voters who are waiting to be persuaded."

The Bottom Line

Multiple Democratic Senate and House candidates have embraced Medicare for All as part of their platforms this election cycle, including Graham Platner of Maine, Juliana Stratton of Illinois, Abdul El-Sayed of Michigan, Bob Brooks of Pennsylvania's 7th Congressional District, and Adam Hamawy of New Jersey's 12th Congressional District. The party faces a strategic question heading into the midterms: whether to push for incremental reforms that can pass Congress or more sweeping changes that energize progressive voters but may face greater opposition.